Scoring written feedback identified that tasks were often specifically described, but performance gaps and action plans were less frequently and specifically mentioned. Educators might improve feedback effectiveness by better articulating to trainees the gap between their performance and an expert standard, as well as by providing them with specific learning plans.
OBJECTIVES Direct observation is the foundation of assessment and learning in competency-based medical education (CBME). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high-quality direct observation. This is particularly true in specialties where observation of nonprocedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation. In this study, we explored perceptions of direct observation in internal medicine.METHODS We interviewed internal medicine attending physicians (n = 9) and residents (n = 8) at the University of Toronto, purposively sampled for diversity. Using a constructivist grounded theory approach, constant comparative analysis was performed to develop a framework to understand perceptions of direct observation on the clinical teaching units. RESULTS Participants articulated a narrow perception of what constitutes directobservation, in contrast to their own descriptions of skills that were observed. This resulted in the perception that certain valuable skills that participants felt were routinely observed were nonetheless not 'directly observable', such as clinical reasoning, observed through case presentations and patient care discussions. Differentiating direct observation from informal observation led to overestimation of the time and resource requirements needed to enhance direct observation, which contributed to scepticism and lack of engagement related to CBME implementation.CONCLUSIONS In an internal medicine training programme, perceptions of what constitutes direct observation can lead to under-recognition and hinder acceptance in workplace-based assessment and learning. Our results suggest a reframing of 'direct observation' for residents and attending physicians, by explicitly identifying desired skills in non-procedurally-based specialties. These findings may help CBME-based training programmes improve the process of direct observation, leading to enhanced assessment and learning.
Introduction Entrustable professional activities (EPAs), discrete profession‐specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programmes. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA framework poses a crucial but often difficult first step. The logic of an EPA framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programmes. Methods A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis. Results In total, 42 studies were included. Most studies were conducted in the United States (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), paediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified, namely, ‘service provision’, ‘procedures’ and/or ‘disease or patient categories’. The majority of papers (n = 37; 88%) used two or more logics when developing EPA frameworks (median = 3, range = 1–4). Disease or patient groups and service provision were the most common logics used (39% and 37%, respectively). Conclusions Most programmes used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.
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